Malcolm Needs

Is someone going to say "I have a little Rhode Island in me?"

I must have some connection to RI myself.  

The reason the method is not recommended is because the manufacturer does not have sufficient data to support the use and what they are telling you is essentially an off label use for their product.  So legally they cannot make an official recommendation but they can tell you what is technically possible and that you need to validate it or QC it yourself.  Even then I would be shocked to see them put this into writing.
 
Undoubtedly, this works fine but manufacturers are constrained by regulations as to what they can recommend as the use for their products.

Thank you for your kind comment David.
 
Anti-M is the bane of my life!
 
Until relatively recently, if an anti-M was referred to my laboratory, we would test it first by Bio-Rad (Used to be Dia-Med) gel IAT and enzyme technique (enzyme technique to see if anything else is there - even I know that the M antigen is destroyed by papain!!!!!!!!!) to make sure that there was an anti-M present.  If there was an anti-M present, we would then test it by pre-warmed, warm-washed LISS tube IAT at 37oC.  If we saw no reactions by this technique, we would advise that cross-match compatible blood would be suitable, and safe, for transfusion.  If we did see reactions by this technique, we would advise that M- typed blood should be cross-matched, and those compatible transfused.
 
The reason for the difference between the gel technique and the tube technique is two-fold.
 
Firstly, in the gel technique, the reactants (plasma and red cells) are introduced to each other at room temperature, and then the cassettes are put into a 37oC incubator.  "Cold-reactive" antibodies can sensitise red cells in "peco-seconds" (I may have exaggerated a bit there!!!!!!!!!!!), but the antibody-antigen complex takes a bit of time to dissociate (longer than the incubation time), and so a "false IAT positive reaction" is seen.  On the other hand, if the reactants are introduced to each other, already at 37oC, "cold-reacting" anti-M will (eventually) sensitise red cells, but not in the time allowed for incubation, and so the reaction would be negative.
 
The second reason is that the column containing the AHG is slightly acidic, and if there is one antibody/antigen reaction that likes acidic reactions, it is that between anti-M and the M antigen.
 
I was quite happy with this situation, BUT, and my own line manager is well aware of this, so I don't mind saying it publically, NHSBT has decided, on the grounds that most of our hospitals use gel techniques, we now recommend giving M- typed blood to anyone who has an anti-M, which I think is a total waste of units of blood that have been typed for all sorts of other antigens and have been found to have (presumed) homozygous expression for other, more useful, antigens.
 
I am well aware of the fact that anti-M can cause haemolytic transfusion reactions (IF serologically reactive at 37oC) and can cause clinically significant haemolytic disease of the foetus and newborn (IF serologically reactive at 37oC), and, in the case of HDFN, particularly amongst ethnicities in the Far East, such as the Japanese, irrespective of titre, but these cases are very, very rare.

I must be from Rhode Island originally..

We will use a specimen from anywhere in the lab so long as it's a different draw time, so most of the time it doesn't even involve sticking the patients again.
And for those not from Rhode Island, "Not for nuthin'" is generally followed by "but", then an unsolicited opinion. (Rhode Islanders may be woefully ignorant of the subject material, but that never prevents them from having a strong opinion on the matter!)

Sounds kind of like Dr. McCoy and Mr. Spock on Star Trek.  I THINK NOT ALSO.

Transfusion Services should be very concerned about how to avoid WBIT (wrong blood in tube). There are two approaches to this problem, 1)one approach is to focus on testing errors and the other is 2)to focus on specimen collection errors. Repeat testing of the same blood sample (by the same person or different persons) will only detect testing errors. Testing a second blood sample (preferably collected at a different time and by a different phlebotomist) will also detect specimen collection errors, i.e., blood samples collected from wrong patient or blood samples labeled with wrong patient demographics.

As far as I am aware, 10 weeks gestation is too early for foetal genotyping.
 
We use 15 weeks gestation in the UK.
 
The other thing is, with Specialised Foetal Medicine Units able to "salvage" (hate the word, but that is the one in vogue) foetuses, when the mother has a gigantic anti-D quantification (>400 IU/mL, when we get worried about 20 IU/mL) or titre, why terminate?

This is the type of procedure that would be unique to each Blood Bank; you have to make up a plan made for your specific design and situation. You need an internal disaster plan that includes a relocation of your Blood Bank operation, including:
Move of blood products (emergency power requirements, in a secured area...)
Move of manuals/records (are your procedures online and available on other computers?)
Move of operations (how to perform testing elsewhere)
Resources (blood, more staffing, communication, etc)
At my previous hospital we had a "disaster box", a plastic container with everything needed to set up a functional Blood Bank elsewhere (test tubes, gloves, rack, etc) with a list taped to the top of the box of reagents/equipment needed that couldn't be in the box. We performed a disaster drill: the scenario was that there was an explosion in the Lab and we had less than 10 minutes to evacuate. We came up with a disaster plan, made the disaster box, and quickly grabbed a centrifuge and reagents, etc. Our Helmer refrigerator is on wheels so we unplugged it with the blood supply in it and rolled it to the ER, where we set up an interim Blood Bank. The battery backup lasted until we got there with plenty of battery left. It was actually fun, and we were pretty proud that we were completely set up in the ER ready to go in about 10 minutes.
So have a brainstorming session with your staff...what would happen if...fire in the Lab, flood in the Lab...how would we get the blood out, where would we go, how would we communicate with each other and the blood center?

I wouldn't worry too much about it, to be honest CMCDCHI.
We see this quite often. It is really only the fact that gel technology is much more sensitive than tube technique, but, every now and again, gel technology is, if you like, "too sensitive". It means that the red cells are, without doubt, sensitised in vivo by either an antibody, or an antibody that has resulted in C3d coating of the red cells (or both), but it does not necessarily mean that this is clinically significant.

I think I can shed some light on to why a serological cross-match should be performed once a clinically significant antibody has been detected.
Once such an antibody has been made, it has been shown that the recipient is a responder. It has been further shown that, once such an antibody has been made, the recipient is likely to make further antibodies. These "further antibodies" include specificities directed against low incidence antigens of all specificities (by that, I mean, not just the antigens in the 701 series, but also those assigned to Blood Group Systems and Blood Group Collections). Many of these antibodies will be clinically insignificant, but some are quite definitely clinically significant, and it is to detect these, in the cross-match, which would not be detected either in the screen or the antibody panel, which require to be detected in the serological cross-match.
Whilst someone making these "extra specificities" may, in itself be rare, that was the arguement put forward in the Guidelines.

In brief lawblood, and from my point of view, yes!

Dear Kelly
Well, when you have the results of the right test, please do feel free to come back to us.
We'll do what we can.
Best wishes
anna

Almost daily!

Yes, is the simple answer kmmoton, but be careful.  As you are no doubt aware, anti-Jka can be extremely labile, and will find any excuse not to play by the rules!!!!!!!!!!!!!!!!!!!!

In that case Kelly, there is even less to worry about.
 
If your husband does not carry the RHE gene, he cannot pass it on to your baby, and so the baby will not express the E antigen.  If there is no E antigen present on the baby's red cells, your own anti-E cannot "attack" the baby's red cells.
 
Both anti-E and anti-Cw can be, what is termed "naturally occurring".  By this, we mean that they can be stimulated by something other than exposure to red cells by either transfusion or pregnancy.  Of course, in reality, they cannot be "naturally occurring", and must have been stimulated by something, but the stimulus is most probably something like a bacterium, many or which carry proteins and sugars on their surface that mimic humanblood group antigens closely enough to stimulate the immune system to produce antibodies against these proteins and sugars, but these antibodies are almost always clinically insignificant, and nothing whatsoever to worry about.
 
Have a great pregnancy and enjoy your new baby when he/she arrives into the big wide world!

In that case Kelly, there is even less to worry about.
 
If your husband does not carry the RHE gene, he cannot pass it on to your baby, and so the baby will not express the E antigen.  If there is no E antigen present on the baby's red cells, your own anti-E cannot "attack" the baby's red cells.
 
Both anti-E and anti-Cw can be, what is termed "naturally occurring".  By this, we mean that they can be stimulated by something other than exposure to red cells by either transfusion or pregnancy.  Of course, in reality, they cannot be "naturally occurring", and must have been stimulated by something, but the stimulus is most probably something like a bacterium, many or which carry proteins and sugars on their surface that mimic humanblood group antigens closely enough to stimulate the immune system to produce antibodies against these proteins and sugars, but these antibodies are almost always clinically insignificant, and nothing whatsoever to worry about.
 
Have a great pregnancy and enjoy your new baby when he/she arrives into the big wide world!

Hi Amy,
My first thought was, why did the overnight person give group A blood, rather than group AB? But, perhaps you do not carry group AB in your stock.
Between 1 and 2% of the random White and Black population are A2B, and of those, only 25% produce an anti-A1. An anti-A1 that is clinically significant (reacts at 37oC) is disappearingly rare, so I wouldn't worry about it, but why switch to group O?
The ABO antigens are not direct gene products, but are the result of the action of transferase enzymes that ARE direct gene products (give or take a bit of post-translational jiggery pokery!) and the A transferase and the B transferase compete with one another to put their own terminal sugar residues on to the Type 1 and Type 2 backbones, and it is not unusual for the A antigen to be weaker than the B (so that an A1 reacts more strongly with anti-A than does an A1B, and an A2 reacts more strongly with anti-A than does an A2B).
This patient is also an elderly oncology patient, and both age and his condition can affect the expression of ABO antigens.
I would switch back to group A for transfusion if I were you (or, better still, AB).

In that case Kelly, there is even less to worry about.
 
If your husband does not carry the RHE gene, he cannot pass it on to your baby, and so the baby will not express the E antigen.  If there is no E antigen present on the baby's red cells, your own anti-E cannot "attack" the baby's red cells.
 
Both anti-E and anti-Cw can be, what is termed "naturally occurring".  By this, we mean that they can be stimulated by something other than exposure to red cells by either transfusion or pregnancy.  Of course, in reality, they cannot be "naturally occurring", and must have been stimulated by something, but the stimulus is most probably something like a bacterium, many or which carry proteins and sugars on their surface that mimic humanblood group antigens closely enough to stimulate the immune system to produce antibodies against these proteins and sugars, but these antibodies are almost always clinically insignificant, and nothing whatsoever to worry about.
 
Have a great pregnancy and enjoy your new baby when he/she arrives into the big wide world!

Update: thanks again because of everyone's help we enquired further and the wrong test was done so ier are in the. process of getting the right test. What an amazing site and dedicated members that provide a wonderful backup for people to double check their situation. Thanks again!

Hi Kelly,
 
Anna, John and goodchild are all quite correct, but, in a way, goodchild is the most correct of the three!
 
The problem is that we, in the world of blood transfusion, may well be experts in what we do, but are amongst the worst in the world for naming the antigens and antibodies with which we work.  It actually does make a huge difference as to whether we are talking about a "lower case e" or an "upper case E), and the only cw antigen is actually an "upper case C" and a "lower case w".  What I can say is that all of these antigens were named many years ago, so the mix up is not the fault of anyone who writes on this website!!!!!!!!!!!!!!
 
If you could clarify whether you have an anti-E or an anti-e, that would be great, but, that having been said, neither antibody is renowned for causing any big problems in pregnancy, and neither is anti-Cw.
 
Sorry to be so pedantic, but the correct name of the antibody really is important.

In that case Kelly, there is even less to worry about.
 
If your husband does not carry the RHE gene, he cannot pass it on to your baby, and so the baby will not express the E antigen.  If there is no E antigen present on the baby's red cells, your own anti-E cannot "attack" the baby's red cells.
 
Both anti-E and anti-Cw can be, what is termed "naturally occurring".  By this, we mean that they can be stimulated by something other than exposure to red cells by either transfusion or pregnancy.  Of course, in reality, they cannot be "naturally occurring", and must have been stimulated by something, but the stimulus is most probably something like a bacterium, many or which carry proteins and sugars on their surface that mimic humanblood group antigens closely enough to stimulate the immune system to produce antibodies against these proteins and sugars, but these antibodies are almost always clinically insignificant, and nothing whatsoever to worry about.
 
Have a great pregnancy and enjoy your new baby when he/she arrives into the big wide world!

"The midwife's small hospital does the test."...........Hmmmm....Sounds fishy to me.
 
I wonder if she's all confused and is really talking about our regular old Fetal Maternal Hemorrhage (FMH) Test, since the FMH Test does pick up Rh Positive Cells (but in a post-partum specimen, not a pre-partum specimen.)  .....Just a thought.....
 
 
Donna

Well since we are a community hospital we'd send anything we couldn't identify to you, Malcolm. But since we are in the states, our IRL, lol.